Clinton J Devin1, Silky Chotai1, Matthew J McGirt2, Alexander R Vaccaro3, Jim A Youssef4, Douglas G Orndorff4, Paul M Arnold5, Anthony K Frempong-Boadu6, Isador H Lieberman7, Charles Branch8, Hirad S Hedayat8, Ann Liu8, Jeffrey C Wang9, Robert E Isaacs10, Kris E Radcliff11, Joshua C Patt2, Kristin R Archer. 1. Department of Orthopedics and Neurosurgery, Vanderbilt University Medical Center, Nashville, TN. 2. Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, NC. 3. Department of Orthopedics, Thomas Jefferson University and Rothman Institute, Philadelphia, PA. 4. Spine Colorado, Durango, CO. 5. Department of Neurosurgery, University of Kansas Med Center, Kansas City, KS. 6. Department of Neurosurgery, New York University Langone Medical Center, New York, NY. 7. Scoliosis and Spine Tumor Center, Texas Back Institute, Texas Health Presbyterian Hospital Plano, Plano, TX. 8. Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston Salem, NC. 9. Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA. 10. Division of Neurological Surgery, Department of Surgery, Duke University Medical Center, Durham, NC. 11. Department of Orthopedics, Rothman Institute, Thomas Jefferson University, Egg Harbor Township, NJ.
Abstract
STUDY DESIGN: Secondary analysis of data from a prospective multicenter observational study. OBJECTIVE: The aim of this study was to evaluate the occurrence of surgical site infection (SSI) in patients with and without intrawound vancomycin application controlling for confounding factors associated with higher SSI after elective spine surgery. SUMMARY OF BACKGROUND DATA: SSI is a morbid and expensive complication associated with spine surgery. The application of intrawound vancomycin is rapidly emerging as a solution to reduce SSI following spine surgery. The impact of intrawound vancomycin has not been systematically studied in a well-designed multicenter study. METHODS: Patients undergoing elective spine surgery over a period of 4 years at seven spine surgery centers across the United States were included in the study. Patients were dichotomized on the basis of whether intrawound vancomycin was applied. Outcomes were occurrence of SSI within postoperative 30 days and SSI that required return to the operating room (OR). Multivariable random-effect log-binomial regression analyses were conducted to determine the relative risk of having an SSI and an SSI with return to OR. RESULTS: .: A total of 2056 patients were included in the analysis. Intrawound vancomycin was utilized in 47% (n = 966) of patients. The prevalence of SSI was higher in patients with no vancomycin use (5.1%) than those with use of intrawound vancomycin (2.2%). The risk of SSI was higher in patients in whom intrawound vancomycin was not used (relative risk (RR) -2.5, P < 0.001), increased number of levels exposed (RR -1.1, P = 0.01), and those admitted postoperatively to intensive care unit (ICU) (RR -2.1, P = 0.005). Patients in whom intrawound vancomycin was not used (RR -5.9, P < 0.001), increased number of levels were exposed (RR-1.1, P = 0.001), and postoperative ICU admission (RR -3.3, P < 0.001) were significant risk factors for SSI requiring a return to the OR. CONCLUSION: The intrawound application of vancomycin after posterior approach spine surgery was associated with a reduced risk of SSI and return to OR associated with SSI. LEVEL OF EVIDENCE: 2.
STUDY DESIGN: Secondary analysis of data from a prospective multicenter observational study. OBJECTIVE: The aim of this study was to evaluate the occurrence of surgical site infection (SSI) in patients with and without intrawound vancomycin application controlling for confounding factors associated with higher SSI after elective spine surgery. SUMMARY OF BACKGROUND DATA: SSI is a morbid and expensive complication associated with spine surgery. The application of intrawound vancomycin is rapidly emerging as a solution to reduce SSI following spine surgery. The impact of intrawound vancomycin has not been systematically studied in a well-designed multicenter study. METHODS:Patients undergoing elective spine surgery over a period of 4 years at seven spine surgery centers across the United States were included in the study. Patients were dichotomized on the basis of whether intrawound vancomycin was applied. Outcomes were occurrence of SSI within postoperative 30 days and SSI that required return to the operating room (OR). Multivariable random-effect log-binomial regression analyses were conducted to determine the relative risk of having an SSI and an SSI with return to OR. RESULTS: .: A total of 2056 patients were included in the analysis. Intrawound vancomycin was utilized in 47% (n = 966) of patients. The prevalence of SSI was higher in patients with no vancomycin use (5.1%) than those with use of intrawound vancomycin (2.2%). The risk of SSI was higher in patients in whom intrawound vancomycin was not used (relative risk (RR) -2.5, P < 0.001), increased number of levels exposed (RR -1.1, P = 0.01), and those admitted postoperatively to intensive care unit (ICU) (RR -2.1, P = 0.005). Patients in whom intrawound vancomycin was not used (RR -5.9, P < 0.001), increased number of levels were exposed (RR-1.1, P = 0.001), and postoperative ICU admission (RR -3.3, P < 0.001) were significant risk factors for SSI requiring a return to the OR. CONCLUSION: The intrawound application of vancomycin after posterior approach spine surgery was associated with a reduced risk of SSI and return to OR associated with SSI. LEVEL OF EVIDENCE: 2.
Authors: Gennadiy A Katsevman; Scott D Daffner; Nicholas J Brandmeir; Sanford E Emery; John C France; Cara L Sedney Journal: Spine J Date: 2019-12-24 Impact factor: 4.166
Authors: James X Liu; Dalibel Bravo; John Buza; Thorsten Kirsch; Oran Kennedy; Andrew Rokito; Joseph D Zuckerman; Mandeep S Virk Journal: J Orthop Date: 2018-01-30
Authors: Howard Young Park; William Sheppard; Ryan Smith; Jiayang Xiao; Jonathan Gatto; Richard Bowen; Anthony Scaduto; Langston Holly; Daniel Lu; Duncan McBride; Arya Nick Shamie; Don Young Park Journal: J Spine Surg Date: 2018-06